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PubMed1975

Effect of varying perfusion pressures on the output of sodium and renin and the vascular resistance in kidneys of rats with "post-salt" hypertension and Kyoto spontaneous hypertension.

Isolated kidneys from both "post-salt" normotensive and hypertensive rats were perfused with blood from donor rats at varying pressures. At 130 mm Hg inflow pressure 15 "post-salt normotensive" kidneys put out 0.75 muEq Na/min/g kidney while 14 "post-salt hypertensive" kidneys put out 0.28 mu-Eq Na/min/g (P less than 0.001), a 63% reduction. They also put out 55% less water (P less than 0.002). Thus, if "hypertensive" kidneys are perfused at normal pressures, they put out subnormal amounts of Na and H-2-O. Such Na and H-2-O retention maintains the hypertensive state. Normal Na output in these kidneys was only reached at hypertensive (160) inflow pressures. This shift in the "pressure natriuresis" curve explains in part how some "hypertensive" kidneys maintain hypertension. These "hypertensive" kidneys have grossly abnormal autoregulation curves, each increment of pressure actually producing progressively greater increments of blood flow. Isolated kidneys from Kyoto hypertensive and normotensive rats showed no difference in Na and H-2-O excretion at 130 mm Hg inflow pressure. Thus, a tendency to Na retention demonstrable in the isolated kidney is apparently not supporting Kyoto hypertension. Moreover, isolated kidneys form Kyoto hypertensive rats released significantly lower amounts of renin at all levels of inflow pressure, averaging a 70% lower rate than Kyoto normotensive kidneys (P less than 0.01). Hence, Kyoto hypertension is not supported by a supernormal renin release inherent in the kidney. One can speculate that Kyoto hypertensive rats normally have an elevated sympathetic tone which stimulates release of renin. The denervation which occurs in isolating kidneys might therefore produce a proportionally greater percentage loss of sympathetic influence in these kidneys, which could possibly account for some of their reduced renin release. These Kyoto hypertensive kidneys are apparently not "reset" to maintain hypertension with either Na or renin.

Animals↗
PubMed1977

Pathogenesis of spontaneous hypertension as a model for essential hypertension.

Hypertension in spontaneously hypertensive rats (SHR) develops initially without any obvious organic lesions, and mainly with hemodynamic alteration due to increased peripheral vascular resistance. It is then followed later by various cardiovascular complications such as stroke. These facts indicate that this spontaneous hypertension is very similar to essential hypertension in man. Studies on the pathogenic mechanisms of spontaneous hypertension up to the present have revealed the following points. (1) This hypertension is genetically transmitted to the offspring in an additive mode by a relatively small number of major genes; (2) Environmental factors such as stress and salt-loading accelerate the hypertension; (3) Parabiosis between SHR and normotensive rats offered no positive evidence indicating the involvement of any strong humoral factors; (4) Assays on adrenal and thyroid hormones have suggested that this hypertension is not a simple endocrine hypertension; (5) The destruction of the central nervous system or sympathectomy on blood pressure or peripheral vascular resistance, as well as the recording of spontaneous sympathetic discharge, etc. have indicated the positive involvement of the autonomic nervous system in the development of this hypertension; (6) Changes in the enzyme activities of the central nervous system and in the central responses to various candidates of central neurotransmitters suggested that 'noradrenergic inhibitory mechanisms for blood pressure regulation in the brainstem' (Yamori, Lovenberg and Sjoerdsma, 1970) might be insufficient and result in the initial enhancement of peripheral vasomotor tone causing labile hypertension; (7) Noradrenalin turnover study of the heart and hindlimb perfusion experiments indicated that the neural factor was mainly involved in the development or the early stage of hypertension; this finding was further supported by the increased noradrenalin level or dopamine-beta-hydroxylase activity in the blood; (8) Histometrical studies indicated that the structural component of the peripheral vascular resistance stabilized the hypertension; (9) The initial neurogenic factors and successive involvement of nonneurogenic factors are relayed by the acceleration of protein metabolism of the vascular wall ('adaptive metabolic change', Yamori, 1974). This acceleration is commonly detected by amino acid incorporation study in both spontaneous and other experimental hypertension; (10) Increased lysine incorporation into the noncollagenous protein of the mesenteric arteries detected in the prehypertensive SHR was experimentally confirmed to be influenced by neural innervation. This confirmation indicated the importance of such a trophic effect of the nervous system on the structural alteration of blood vessels in the development of hypertension (neurovascular linkage, Yamori, 1975)...

Acetylcholinesterase↗
PubMed1997

Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy.

OBJECTIVE: To provide Canadian physicians with comprehensive, evidence-based guidelines for the nonpharmacologic management and prevention of gestational hypertension and pre-existing hypertension during pregnancy. OPTIONS: Lifestyle modifications, dietary or nutrient interventions, plasma volume expansion and use of prostaglandin precursors or inhibitors. OUTCOMES: In gestational hypertension, prevention of complications and death related to either its occurrence (primary or secondary prevention) or its severity (tertiary prevention). In pre-existing hypertension, prevention of superimposed gestational hypertension and intrauterine growth retardation. EVIDENCE: Articles retrieved from the pregnancy and childbirth module of the Cochrane Database of Systematic Reviews; pertinent articles published from 1966 to 1996, retrieved through a MEDLINE search; and review of original randomized trials from 1942 to 1996. If evidence was unavailable, consensus was reached by the members of the consensus panel set up by the Canadian Hypertension Society. VALUES: High priority was given to prevention of adverse maternal and neonatal outcomes in pregnancies with established hypertension and in those at high risk of gestational hypertension through the provision of effective nonpharmacologic management. BENEFITS, HARMS AND COSTS: Reduction in rate of long-term hospital admissions among women with gestational hypertension, with establishment of safe home-care blood pressure monitoring and appropriate rest. Targeting prophylactic interventions in selected high-risk groups may avoid ineffective use in the general population. Cost was not considered. RECOMMENDATION: Nonpharmacologic management should be considered for pregnant women with a systolic blood pressure of 140-150 mm Hg or a diastolic pressure of 90-99 mm Hg, or both, measured in a clinical setting. A short-term hospital stay may be required for diagnosis and for ruling out severe gestational hypertension (preeclampsia). In the latter case, the only effective treatment is delivery. Palliative management, dependent on blood pressure, gestational age and presence of associated maternal and fetal risk factors, includes close supervision, limitation of activities and some bed rest. A normal diet without salt restriction is advised. Promising preventive interventions that may reduce the incidence of gestational hypertension, especially with proteinuria, include calcium supplementation (2 g/d), fish oil supplementation and low-dose acetylsalicylic acid therapy, particularly in women at high risk for early-onset gestational hypertension. Pre-existing hypertension should be managed the same way as before pregnancy. However, additional concerns are the effects on fetal well-being and the worsening of hypertension during the second half of pregnancy. There is, as yet, no treatment that will prevent exacerbation of the condition. VALIDATION: The guidelines share the principles in consensus reports from the US and Australia on the nonpharmacologic management of hypertension in pregnancy.

Female↗
PubMed1991

Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics.

The prevalence of pulmonary hypertension in 507 patients hospitalized with portal hypertension but without known pulmonary hypertension who underwent cardiac catheterization was prospectively studied. Ten (2%) of these patients, 6 of whom were clinically asymptomatic, had primary pulmonary hypertension. Second, 26 patients with symptomatic pulmonary hypertension complicating portal hypertension were reviewed. Pulmonary hypertension occurred later after diagnosis of portal hypertension in patients with a surgical shunt (10 patients) than in those without a shunt (147 +/- 49 vs. 44 +/- 27 months; P less than 0.0001). Cardiac index correlated inversely with pulmonary arterial pressure (r = -0.45; P less than 0.01) and was lower in the 5 patients who died of pulmonary hypertension than in the 5 who died of liver failure (1.52 +/- 0.14 vs. 3.69 +/- 1.88 L/min.m2; P less than 0.05). Third, systemic and splanchnic hemodynamics were compared in 285 patients with alcoholic cirrhosis and 29 controls. No significant relation was found between elevated pulmonary vascular resistance and increased portal pressure, zzygos blood flow, or cardiac index. Pulmonary hypertension is considerably more frequent than was previously estimated in patients with portal hypertension. The risk of developing pulmonary hypertension could increase with the duration of portal hypertension without any clear relation to the degree of portal hypertension, hepatic failure, or amount of blood shunted.

Cardiac Catheterization↗
PubMed2005

Reduced nocturnal blood pressure dip and sustained nighttime hypertension are specific markers of secondary hypertension.

OBJECTIVE: To investigate with the use of ambulatory blood pressure (BP) monitoring whether nocturnal BP dip and nighttime BP values are different in children with untreated primary and secondary hypertension. STUDY DESIGN: Ambulatory BP monitoring studies from 145 children with untreated hypertension were retrospectively analyzed. Forty-five children had primary hypertension and 100 children had secondary hypertension. RESULTS: Children with secondary hypertension had lower nocturnal BP dip for systolic and diastolic BP in comparison to children with primary hypertension (8% +/- 5% vs 14% +/- 4% for systolic and 14% +/- 7% vs 22% +/- 5% for diastolic BP, P < .0001 for both). Eleven percent of children with primary hypertension were classified as nondipper (BP dip <10%) for systolic BP and no child for diastolic BP; on the contrary, in children with secondary hypertension, 65% were nondippers for systolic and 21% for diastolic BP. Nocturnal systolic and diastolic BP loads were significantly greater in children with secondary hypertension than in those with primary hypertension. CONCLUSIONS: Reduced nocturnal BP dip and sustained nighttime BP elevation are specific markers of secondary hypertension in children with untreated hypertension. Children with blunted nocturnal BP dip or sustained nighttime hypertension should be thoroughly investigated searching for the underlying cause of hypertension.

Adolescent↗
PubMed2003

The role of parental hypertension in the frequency and age of diagnosis of hypertension in offspring with autosomal-dominant polycystic kidney disease.

BACKGROUND: Hypertension in autosomal-dominant polycystic kidney disease (ADPKD) patients is associated with more rapid progression of renal disease and a high incidence of left ventricular hypertrophy (LVH). The present study was undertaken to examine the role of parental hypertension in the occurrence of hypertension in 475 ADPKD offspring. METHODS: Adult subjects participating in an ongoing study of the natural history of ADPKD were included in the analysis if they were diagnosed with ADPKD, had a known affected parent, and knew the hypertensive status of both parents. RESULTS: When the affected parent was hypertensive, the ADPKD male (82% versus 62%, P < 0.05) and female (61% versus 37%, P < 0.005) offspring had a significantly higher frequency of hypertension than when the ADPKD-affected parent was normotensive. The median age of diagnosis of hypertension was also significantly earlier in both male (33 years versus 40 years, P < 0.05) and female (38 years versus 50 years, P < 0.05) ADPKD patients when their affected parents were hypertensive as compared with normotensive. These effects of hypertension in the affected parent on hypertension in the ADPKD offspring were independent of age, renal volume, and renal function in the offspring. Hypertension in unaffected parents also increased the frequency of hypertension in the ADPKD female (69% versus 53%, P < 0.01), but not male (89% versus 77%, NS) subjects. CONCLUSION: The results indicate that parental hypertension influences the frequency of hypertension in ADPKD patients.

Adult↗
PubMed1995

'White-coat' hypertension in patients with newly diagnosed hypertension: evaluation of prevalence by ambulatory monitoring and impact on cost of health care.

To evaluate the prevalence of 'white-coat' hypertension in patients with newly diagnosed hypertension, 255 subjects (131 males and 124 females) underwent 24-h ambulatory blood pressure monitoring. Patients with 24-h systolic and diastolic blood pressure < 135/85 mmHg were classified as white-coat hypertensives and the remaining as sustained hypertensives. On the assumption that white-coat hypertensives may not need to take antihypertensive medication, we evaluated the impact on cost of health care of two strategies based essentially on treating all patients according to casual blood pressure, or ambulatory blood pressure monitoring, followed by drug treatment in sustained hypertensives only. Of the 255 hypertensives studied, 54 (21%), confidence interval 16%, 26%, were classified as white-coat hypertensives. The age, sex-ratio and body mass index did not differ between the white-coat and the sustained hypertensive subjects. The strategy of monitoring all patients and of treating only the sustained hypertensives resulted in a substantial coat saving, which was calculated to be about 110,000 U.S.A. dollars over a period of 6 years. In conclusion, white-coat hypertensives are frequent among patients with newly diagnosed hypertension, and they do not differ from sustained hypertensives as regards demographic data. Ambulatory blood pressure monitoring, when used to decide whether or not to treat pharmacologically, increases the cost-effectiveness of treatment for hypertension and reduces the cost of health care.

Adult↗
PubMed2003

Reduced activity of the kallikrein-kinin system predominates over renin-angiotensin system overactivity in all conditions of sodium balance in essential hypertensives and family-related hypertension.

OBJECTIVE: To study the renin-angiotensin-aldosterone and kallikrein-kinin systems in essential hypertensives and offspring of hypertensive parents during different sodium loads, and to explore their possible influence on renal hemodynamics. METHODS: Forty-five essential hypertensives (35 +/- 4 years old, 25 males), 30 offspring of hypertensive parents (26 +/- 8 years old, 16 males) and 30 normotensive controls (28 +/- 5 years old, 20 males) were submitted to three different sodium loads (high, 250 mmol/l; normal, 140 mmol/l; and low, 20 mmol/l). Blood pressure, plasma renin activity, serum aldosterone, total kallikrein and urinary kallikrein-like activity were measured after each period. Effective renal plasma flow and glomerular filtration rate were also measured. In essential hypertensive subjects, renal hemodynamic and hormonal parameters were also measured after 3 days of 20 mg enalapril administration. RESULTS: Plasma renin activity and serum aldosterone were higher in normotensives, essential hypertensives and offspring of hypertensive parents only during low sodium intake, whereas urinary kallikrein activity was lower in hypertensive offspring and essential hypertensives, compared with normotensives, during the three diet conditions. Effective renal plasma flow was found to be reduced in hypertensives and normotensive offspring, while the glomerular filtration rated was similar in the three groups. Angiotensin converting enzyme inhibitor (ACEI) administration to essential hypertensives for 3 days normalized effective renal plasma flow, increased plasma renin activity and decreased aldosterone and urinary kallikrein activity. CONCLUSIONS: Our observations confirmed the presence of a hormonal imbalance between the renin-angiotensin-aldosterone system and the kallikrein-kinin system, not only in essential hypertensives but also in the offspring of hypertensive parents. This imbalance probably affects the renal circulation and sodium homeostasis, since there was reduced effective renal plasma flow in both populations compared with normotensive subjects. The positive effect of ACEI, resulting in normalization of the effective renal plasma flow in essential hypertensive patients, suggests the involvement of both systems in impaired renal circulation.

Adult↗
PubMed1995

Isolated diastolic hypertension. A favorable finding among young and middle-aged hypertensive subjects.

To identify pretreatment characteristics associated with subsequent myocardial infarction in young and middle-aged previously untreated hypertensive individuals, we examined the experience of 1560 participants in a work-site hypertension control program who were younger than 60 years. Subjects were categorized by initial blood pressure as having isolated diastolic hypertension (< 160/> or = 90 mm Hg, n = 965) or combined systolic and diastolic hypertension (> or = 160/> or = 90 mm Hg, n = 595). During 4.5 years of follow-up, there were 24 myocardial infarctions, yielding an overall incidence of 3.89 per 1000 person-years. Subjects with systolic/diastolic hypertension were older, had higher cholesterol and blood sugar levels, and included more smokers and people with left ventricular hypertrophy on electrocardiogram than those with isolated diastolic hypertension. Age-adjusted incidence rates for myocardial infarction were 5.20 and 2.21 per 1000 person-years in systolic/diastolic hypertension and isolated diastolic hypertension, respectively, and the relative risk of systolic/diastolic hypertension was 2.31 (95% confidence interval, 1.29-4.15). Among subjects with isolated diastolic hypertension, no myocardial infarction occurred in those with systolic pressure less than 140 mm Hg. Cox regression analysis including other known risk factors showed that pulse pressure, as a continuous variable (hazards ratio, 1.54; 95% confidence interval, 1.08-2.20), and type of hypertension, ie, systolic/diastolic hypertension versus isolated diastolic hypertension (hazards ratio, 2.11; 95% confidence interval, 1.08-4.13), were independently associated with myocardial infarction. These results suggest that young and middle-aged treated hypertensive individuals with normal pretreatment systolic pressure enjoy a more favorable prognosis than do those with systolic elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

"White coat" hypertension and alerting reaction in elderly and very elderly hypertensive patients.

"White coat" hypertension can be demonstrated in 20-25% of younger patients with mild-to-moderate hypertension. In a population of 50 untreated hypertensive patients > or = 70 years (mean age 79 +/- 6 years, office blood pressure > or = 160 mmHg systolic and > or = 95 mmHg diastolic) ambulatory blood pressure monitoring, ECG and echocardiography were performed to assess the frequency of "white coat" hypertension and the alerting reaction ("white coat" effect). "White coat" hypertension was diagnosed, if mean daytime ambulatory blood pressure was < or = 146/87 mmHg (taken as upper "normal" limit), "definite" hypertension, if > 146/87 mmHg. Nine patients (18%) were classified as "white coat", 28(56%) as "definite" hypertensives, 13(26%) as an "intermediate" group. There were no differences in gender, weight, concomitant diseases, pre-study treatment, and systolic or diastolic left ventricular function between the groups. Patients with "white coat" hypertension showed lower office blood pressure (178 +/- 13/98 +/- 3 vs 201 +/- 19/104 +/- 7 mmHg; p < 0.004), lower left ventricular mass index (131 +/- 9 vs 139 +/- 26 g/m2, p < 0.5), no left ventricular hypertrophy (ECG-criteria; p < 0.05), a more pronounced alerting reaction (39 +/- 13/22 +/- 5 vs 27 +/- 17/8 +/- 9; p < 0.01) and no correlation between office blood pressure and left ventricular mass compared to the "definite" hypertension group. The total group showed an average alerting reaction of 30 +/- 19/12 +/- 8 mmHg. It is concluded that "white coat" hypertension and an alerting reaction can be demonstrated in untreated elderly and very elderly hypertensive patients. Patients with "white coat" hypertension are characterized by a milder degree of hypertension, less cardiac target organ damage and a more pronounced alerting reaction. The prognostic significance of "white coat" hypertension in the elderly needs to be reevaluated in a larger population.

Aged↗
PubMed2000

Hypertension and its relation to renal function 10 years after pregnancy complicated by pre-eclampsia and pregnancy induced hypertension.

OBJECTIVE: To assess the development of hypertension and its relation to renal function 10 years after pregnancy complicated by pre-eclampsia and pregnancy induced hypertension. METHODS: Women with pre-eclampsia (n=47), pregnancy induced hypertension (n=54) or normotensive (n=46) during 1988 were reviewed at King Hussein Medical Center, Amman, Jordan, for the development of hypertension and renal disorder. Their renal function was reviewed by measuring blood levels of urea, uric acid, creatinine, calcium and albumin. Urine was examined for microalbuminuria. RESULTS: Women with pre-eclampsia and pregnancy induced hypertension had a higher risk of developing hypertension 10 years later compared to the control group, (23% for pre-eclampsia, and 39% for pregnancy induced hypertension vs. 3% for control). Albumin corrected calcium levels were significantly higher in patients with history of pre-eclampsia (2.41 mmol/l) and pregnancy induced hypertension (2.42 mmol/l) vs. control (2.33 mmol/l) as well as a significant difference in microalbuminuria levels (23% in pre-eclampsia, and 16% in pregnancy induced hypertension vs. 3% in control). Serum urea, creatinine and uric acid levels were not significantly affected (4.4 mmol/l in pre-eclampsia, 4.7 mmol/l in pregnancy induced hypertension and 4.6 mmol/l in control for urea, 76.0 mmol/l in pre-eclampsia, 74.0 mmol/l in pregnancy induced hypertension and 77.0 mmol/l in control for creatinine and 252.0 mmol/l in pre-eclampsia, 250.0 in pregnancy induced hypertension and 248 mmol/l in control for uric acid). CONCLUSION: The risk of development of chronic hypertension 10 years after pregnancy complicated by pre-eclampsia and pregnancy induced hypertension is increased and this is closely related to residual renal disorder.

Adult↗
PubMed1996

Vascular and cardiac overexpression of endothelin-1 gene in one-kidney, one clip Goldblatt hypertensive rats but only in the late phase of two-kidney one clip Goldblatt hypertension.

OBJECTIVE: To investigate a model of experimental hypertension that exhibits severe hypertrophy of small blood vessels but in which deoxycorticosterone acetate (DOCA) and salt are absent: the one-kidney, one clip model of Goldblatt renovascular hypertension, which is non-renin-dependent, and compare it with the renin-dependent two-kidney, one clip Goldblatt hypertensive rat, in which additionally vascular hypertrophy is less severe. METHODS: Endothelin-1 gene expression in blood vessels and in the heart was examined by Northern blot analysis. RESULTS: After 2 or 4 weeks of application of the silver clip to unilaterally nephrectomized rats, the aorta and mesenteric arteries exhibited a significant increase in the intensity of the 2.3 kb band corresponding to hybridization with endothelin-1 messenger RNA (mRNA) in comparison with results obtained in control unilaterally nephrectomized rats. No increase was noted in the blood vessels of the two-kidney, one clip hypertensive rat at 2 or 4 weeks, but significant increases were found at 8 weeks in aorta, but not in mesenteric arteries. Cardiac abundance of endothelin-1 mRNA was also increased in ventricles and in the left atria of one-kidney, one clip hypertensive rats, but only in the late phase (at 8 weeks) in two-kidney, one clip hypertensive rats. CONCLUSION: Because one-kidney, one clip hypertensive rats presented severe vascular hypertrophy whereas two-kidney, one clip hypertensive rats only did so in the late phase of hypertension, these results lend further support to there being a relationship between vascular hypertrophy and endothelin-1 vascular overexpression in experimental models of hypertension. They also demonstrate that enhancement of the expression of endothelin-1 gene in blood vessels and in the heart of hypertensive rats may occur in the absence of exposure to DOCA and salt, and that endothelin-1 gene overexpression in experimental hypertension occurs early in non-renin-dependent, volume-expanded models such as the one-kidney, one clip or the DOCA-salt hypertensive rat, but only in the progressively non-renin-dependent late phase of the initially renin-dependent volume-contracted two-kidney, one clip hypertensive rat.

Animals↗
PubMed2002

[The frequency and causes of resistant hypertension in primary care practices in the community as compared to those in the district advisory clinic for hypertension].

UNLABELLED: Resistant hypertension is defined as blood pressure that does not drop below 140 mmHg systolic and/or above 90 mmHg diastolic, despite treatment with three drugs in suitable combination and recommended dosage, when one of the drugs is from the diuretic group. The prevalence of resistant hypertension, which has been examined in relatively few studies, ranges between less than 3% and up to 29%. The frequency of these causes has not yet been examined in Israel. The aim of this study is to examine the frequency of patients with resistant hypertension and to compare the frequency of the different causes for this condition in the primary community clinics with those found in the district advisory clinic for hypertension. The medical files of all of the patients above the age of 20, in five rural primary care clinics in the northern district and in the Advisory Clinic for Hypertension, were reviewed to find those patients meeting the criteria of resistant hypertension. The patients that were located and met the inclusion criteria filled out a questionnaire which included demographic characteristics, drug treatment updated to their last visit, and evaluation of the various possible causes for the condition. RESULTS: Resistant hypertension was found in 10 out of 227 hypertensive patients treated in primary clinics (4.4%) and in 21 out of 131 hypertensive patients treated in the Advisory Clinic for Hypertension (16%). For 8 of the patients (25.8%) there was a single cause for resistant hypertension. For 14 patients (45.2%) there were 2-3 causes and for 9 patients (29%) there were 4 or more causes. Low treatment compliance was found in 7 patients, faulty measuring technique in 3 patients and taking drugs that raise blood pressure was found in one patient. Among the accompanying clinical conditions, uncontrolled dyslipidemia was found in 15 patients (48.4%), uncontrolled diabetes in 11 patients (35.5%) and obesity in 10 patients (32.3%). Increased sympathetic activity was found in 6 patients (19.4%) and secondary causes were found in 4 patients (12.9%). CONCLUSIONS: The frequency of resistant hypertension in primary clinics--4.4%, and in the Advisory Clinic for Hypertension--16%, as was found in our study, is identical to that described in the literature and derives from the different nature of the patients treated in each of them. The fact that in half of the patients 2-3 causes were found for resistant hypertension, and in a third of them there were 4 or more causes, emphasizes both the complexity of the medical problems of this patient group and the need for a comprehensive multi-systematic treatment approach.

Adult↗
PubMedDate not supplied

Prevalence of hypertension without anti-hypertensive medications and its association with social demographic characteristics among 40 years and above adult population in Indonesia.

AIM: To find out the prevalence of hypertension without anti-hypertensive medication and its social demographic risk factors among adult population in Indonesia. METHODS: Random samples of 3080 subjects aged 40-94 years were obtained from various districts in every big island in Indonesia. Blood pressure measurements, as well as assessment on history of hypertension, use of anti-hypertensive medications, and social demographic characteristics were performed. Blood pressure measurements were obtained by trained doctors with the subjects in supine position. Stepwise multiple logistic regression was used to determine variables which were most associated with treatment without anti-hypertensive medication in hypertensive subjects. RESULTS: The prevalence of hypertension without anti-hypertensive medication among 40 years and above adult population in Indonesia was 37.32% (677 our of 1814 hypertensive subjects). From bivariate analysis, we found that male sex, older age, informal education and unemployment were associated with the use of anti-hypertensive medication. Multivariate analysis shows that male sex (OR=1.33), education level of elementary school (OR=1.50), and government employment (OR=1.24) are significantly as risk factors for not taking anti-hypertensive medication. Age more than 60 years old (OR=0.49) and unemployment (OR=0.70) are protective factors for not taking anti-hypertensive medication. CONCLUSION: The prevalence of hypertension without anti-hypertensive medication in this study is higher than the prevalence found in some other studies, and due to several social demographic risk factors, such as low level education, male sex, and being government employees. On the other hand, older people and those who have no formal occupation are protective factors.

Adult↗
PubMed1978

[Cardiovascular x-ray findings, changes of the thoracic aorta, electrocardiographic and clinical parameters in hypertension. 1. Cardiovascular x-ray findings in hypertension].

We examined 142 hypertensive patients of special consulting hours for hypertension. In a subdivision into 3 degrees of severity of hypertension and into the age groups less than or equal to 50 years and greater than 50 years X-ray findings on the heart and on the large vessels near the heart were made. Patients with blood pressure values RRs greater than or equal to 160 Torr and RRd greater than or equal to 95 Torr had these findings in 78%. 56% of the test persons with a heart affected in the left ventricle (R1) were found and 23% of the test persons with left-prevailing heart affected on the two sides (R3). The positive correlation between age of the patients with hypertension, duration of hypertension and frequency of the heart deformation in the sense of the left-ventricularly affected heart and the left-prevailing heart affected on the two sides could statistically be ascertained. 62% of the patients less than or equal to 50 years and 89% of the patients greater than 50 years had these findings. In a duration of hypertension less than or equal to 5 years 64% had these findings, in a duration of hypertension greater than 5 years 64%. The total number of findings increases with the degree of severity of hypertension. In test persons with degree II of severity of hypertension (RRs 160-200 Torr, RRd greater than or equal to 95 Torr) 73% had these findings, in test persons with degree III (RRs greater than Torr, RRd greater than or equal to Torr) 86%. The relation of the heart deformation in the sense of the left-prevailing heart affected on the two sides between degree II and III of the severity of hypertension was contradictory. In hypertension II and duration of hypertension greater than 5 years the percentage of the test persons with left-prevailing heart affected on the two sides was 42%, in hypertension III and duration of hypertension greater than 5 years 19%.

Adult↗
PubMed1995

Urinary and plasma endothelin 1 in essential hypertension and in hypertension secondary to renoparenchymal disease.

An alteration in renal metabolism of endothelin may contribute to hypertension in the SHR and it has been shown that the excretion rate of endothelin is reduced in patients with essential hypertension. We measured plasma and urinary endothelin 1 (ET-1) in 20 untreated essential hypertensives with normal renal function, in eight normotensive healthy subjects, and in 13 hypertensive patients with primary renoparenchymal disease. Plasma ET-1 was higher (P < 0.01) in essential hypertensives (median 1.69, interquartile range 1.2-3.3 pg/ml) than in normal subjects (0.84, 0.37-1.10 pg/ml) but significantly less (P < 0.01) than in hypertensives with renoparenchymal disease (3.57, 1.45-9.52 pg/ml). ET-1 levels slightly correlated with diastolic pressure in essential hypertensives (r = 0.43, P < 0.05) and tended to be correlated with systolic pressure in hypertensives with renal disease (r = 0.47, P = 0.08). ET-1 excretion in essential hypertensives (137, 99-154 ng/24 h) and in normal subjects (120, 62-150 ng/24 h) was significantly lower than in renal hypertensives (191, 123-241 ng/24 h). The ET clearance/GFR ratio (ClET/GFR) was markedly reduced (30%, 21-67%) in essential hypertensives and substantially raised in renal hypertensives (164%, 86-314%) in comparison with normal subjects (83%, 35-94%). Since the ClET/GFR ratio should be 100% if all filtered ET-1 is excreted, the data indicate that ET-1 is synthesized at a reduced rate and/or broken down at an enhanced rate by the kidney in essential hypertension and confirm that there is a high ET-1 generation rate in remnant nephrons in hypertension secondary to renal disease.

Adolescent↗
PubMed2000

[What tests should be conducted for secondary arterial hypertension in hypertensive patients resistant to treatment?].

UNLABELLED: The aim of this study was to determine the prevalence of secondary hypertension in a population of refractory hypertension without initial clinical or biological findings suggesting identifiable causes of hypertension. METHODS: A survey included 200 consecutive hypertensive patients referred to hypertension specialists for refractory hypertension (BP > 140/90 mmHg on at least two antihypertensive drugs). Prior inclusion, the permanent elevation of blood pressure was confirmed by ambulatory monitoring. In each subject an extensive work-up was performed to detect a secondary cause for hypertension. RESULTS: An essential hypertension was confirmed in 61% of this cohort. A secondary hypertension was detected in 20% of the patients; 8.5% with a primary hyperaldosteronism, 8% with a reno-vascular hypertension and 3% with a nephropathy. Moreover, 18.5% had a low renin hypertension. Thus, 27% of these patients had an abnormality of the renin-aldosterone axis. CONCLUSION: Patients with refractory hypertension should be explored to detect secondary hypertension even without findings suggesting such causes. This additional diagnostic procedure must include at least renovascular investigations and plasma renin/aldosterone level determinations in appropriate conditions.

Aged↗
PubMed2007

Systolic hypertension in adult Nigerians with hypertension.

OBJECTIVE: To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Cardiovascular Clinic of the University of Ilorin Teaching Hospital, Nigeria, from July 2002 to June 2003. PATIENTS AND METHODS: Newly diagnosed adult hypertensives, with blood pressure >or= 140/90mmHg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. RESULTS: Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. CONCLUSION: Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ damage than the diastolic hypertension.

Adult↗